<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<h1>Payment Information</h1>
</head>

<body>
	<form name="payment_information" action="payment_information_process.php" method="POST">
		Name on Card:		<input type="text" name="name_on_card">		</br>
		Card Number:		<input type="text" name="card_number">		</br>
		CCV:				<input type="text" name="ccv">				</br>
		Expiry Date:		<input type="text" name="expiry_date">		</br>
		Billing Address:	<input type="text" name="billing_address">	</br>
		<input type="submit" value="Submit">
	</form>
</body>
</html>
